Mechanical Valve or Tissue Valve ?

[cldlhd]

I'm just starting to wade through the article. It implies that the gradient across the prosthetic valve is at least partly dependent on body size / weight. I've not heard this before, but it makes sense. So my thinking is that losing weight might decrease the pressure gradient across the valve. Do people think this is right? Would a smaller pressure across the valve mean less haemolysis (reduced LDH)? My mother is overweight and when she had her echo initially they said she had stenosis, but then they did some calculation and said nup. I'm wondering whether this more weight = bigger gradient applies to native valves as well. Extraordinary concept. Thanks again for making me think.

The difference in effective orifice area between the On-X and Regent is significant, especially as the valve size increases. I've got a 27/29 On-X. I guess the 'pannus guard' comes at a 'price'.

It's possible that weight loss might help, I would imagine BP could have an effect also.

 

[Bodhisattva]

I'm just starting to wade through the article. It implies that the gradient across the prosthetic valve is at least partly dependent on body size / weight. I've not heard this before, but it makes sense. So my thinking is that losing weight might decrease the pressure gradient across the valve. Do people think this is right? Would a smaller pressure across the valve mean less haemolysis (reduced LDH)? My mother is overweight and when she had her echo initially they said she had stenosis, but then they did some calculation and said nup. I'm wondering whether this more weight = bigger gradient applies to native valves as well. Extraordinary concept. Thanks again for making me think.

The difference in effective orifice area between the On-X and Regent is significant, especially as the valve size increases. I've got a 27/29 On-X. I guess the 'pannus guard' comes at a 'price'.

Hi Agian,

I think the basic concept behind the effective orifice area index could apply to native valves. Our bodies need a certain amount of cardiac output to properly function and the amount is determined by how much body we have going and how active we are at any time. Native valves that are functioning properly have a big enough valve opening to let enough blood through under varying conditions without creating pressure gradients that go beyond the parameters of normal heart function.

Because body surface area is a combination of our height and weight, and because our height doesn't really change very much, it's my guess our body surface area may not change that much when we lose weight unless it's a huge amount of weight. Maybe like a ballon when you let out just a little bit of air.

 

[pellicle]

Hi

stuff

perhaps this is something of interest (and maybe you've already read it

https://www.dropbox.com/s/wan6oba6ip...73_r1.pdf?dl=0

Back when I was initially digging stuff up about my valve (an ATS) I was interested in the "hydraulics" and the sorts of pressures generated on valve open and close ... although I realise that so far we've been talking about a slightly different aspect, this relates more to coagulation issues

Agian IIRC you have the St Jude, so you may find this interesting
https://www.dropbox.com/s/061x8acap4re52b/dumont_2007_comparison_bileaflet_mhvs_cfd_fsi.pdf?dl=0

even if only to look at the differences in pivot types

 

[Agian]

Hi Agian,

I think the basic concept behind the effective orifice area index could apply to native valves. Our bodies need a certain amount of cardiac output to properly function and the amount is determined by how much body we have going and how active we are at any time. Native valves that are functioning properly have a big enough valve opening to let enough blood through under varying conditions without creating pressure gradients that go beyond the parameters of normal heart function.

Because body surface area is a combination of our height and weight, and because our height doesn't really change very much, it's my guess our body surface area may not change that much when we lose weight unless it's a huge amount of weight. Maybe like a ballon when you let out just a little bit of air.

Definitely a thing, yeah? You can see how losing weight might reduce pressure across the valve and speed up remodelling.
Do you think this would be coupled with a lower LDH?

 

[Agian]

Agian IIRC you have the St Jude, so you may find this interesting
https://www.dropbox.com/s/061x8acap4re52b/dumont_2007_comparison_bileaflet_mhvs_cfd_fsi.pdf?dl=0

even if only to look at the differences in pivot types

I've got an On-X. But I soak this stuff up like a sponge. Knowledge gives me a sense of control, which is my defence against feeling helpless.

 

[pellicle]

.... Knowledge gives me a sense of control, which is my defence against feeling helpless.

Best armor you can have I reckon

 

[shah4u]

Hey guys
I am back with another question this time due to my appointment with a surgeon for which I was trying for over a month and today after seeing him he suggested that I should go ahead with Tissue valve and as per him it can last around 20 years given the maker says 25-30 years plus the side effect of mechanical is same as tissue in long run with tissue being easier to manage since its a normal tissue valve. Now this is becoming trickier than I thought can you guys please help ?

 

[Superman]

I guess you have to ask yourself, how old will you be in 20 years, and will another open heart surgery be something you can handle at that time? How long will that second valve last? Is a 3rd likely? Are you up for that?

Also something that can last 20 years in a lab and something that will last 20 years in a person are two different things.

I went mechanical and only got 19 years out of it due to an aneurysm. A second surgery happened anyway. But that might have been my third had I gone tissue, so who knows?
Do you have an aneurysm that will be repaired / replaced? If not, are you likely to? Can't really know this - I didn't show any signs, then went from 3.2cm - 4.9cm in a year.

Surgeons seem to like tissue valves, but they make their living doing operations. The less they hear from patients between operations, the better. Surgeons also only see people when they need medical intervention, so they may only see bad things that happen with warfarin. If things are going well, your surgeon will never hear from you again with a mechanical valve. Could be a bias there.

In short, it's a tough decision these days. People can give you their views and experience, but ultimately the final decision is yours. Then you live with it and don't look back. Both options are better than the valve you have now.

 

[dornole]

There is no way I would in cold blood sign up for the trauma of a second (let alone 3rd or 4th) reoperation. I seriously doubt I would get 20 years out of a valve given that I am a) young in valve terms (49) b) female c) already have rheumatic heart disease. All those thing esp being young and the rheumatic issue significantly increase the rate of deterioration of a tissue valve. You are SO YOUNG (27 right?) that you could be looking at 7 years on your valve at first and maybe getting longer wear as you age. Operations at 27 . . . .34 . . . 41 . . . 51. . . 65 . . .that seems insane and might not even be possible. Operations at 27, 47 and 67 in the BEST CASE SCENARIO with scar tissue building up each time and increasing the difficulty? Even that seems nuts.

I think if you really wanted tissue and you think you can get by with one more re-op before your natural death age (and hope its a TAVR though that is far from risk-free) that could be a risk worth taking . . . but a best case 3 surgeries and worst case 4-5 seems insane.

Just my 2 cents, others may (and will probably!) disagree - it's a free country and mostly free world . . . good luck with your decision! Don't be afraid to get a second surgical opinion.

 

[shah4u]

Actually I am quite confused with different doc suggesting diff opinion thats why i look up to you people for real life experience and like you said 2nd or maybe 3rd due in time when I will reach about 55-60 something which will be very difficult actually very but then I dont know what to go for and what not.

 

[dick0236]

Hey guys
I am back with another question this time due to my appointment with a surgeon for which I was trying for over a month and today after seeing him he suggested that I should go ahead with Tissue valve and as per him it can last around 20 years given the maker says 25-30 years plus the side effect of mechanical is same as tissue in long run with tissue being easier to manage since its a normal tissue valve. Now this is becoming trickier than I thought can you guys please help ?

My surgeon told me my valve was tested to last 50 years and it appears he was right.....as the 50th "birthday" will be in Aug., 2017. I spoke with him a few years ago, by phone, and he was surprised I had the SAME valve.......I reminded him that he told me it would last 50 years......and he laughed. You have had the opportunity to research all sides of valve choice and now the decision rests with what YOU think is best for you.

BTW, what is your question?

 

[Superman]

During my second open heart surgery, it took them something like four hours just to saw through my sternum. Heeled bone is harder to cut than new bone. Good thing I wasn't awake for that. My recovery was slower and more problematic as well. Not just because it was the second time, but also because I was older than the first time. We tend to heal better when we're younger. I was only in 36 for my second, but surprised by the difference. Would not want to do it again in my 50's.

 

[cldlhd]

I would say some surgeons favor tissue. I had my valve repaired at 45 and my surgeon agreed with my choice of mechanical for my age. Actually just read an article in which he was in a debate/ discussion of tissue vs repair in younger -40's age range,old in your eyes probably- where he said "tissue valves aren't suitable" in younger patients. I posted the article on another thread out here last night. Some people talk about your 3rd or 4th OHS as if it's the same as changing a light bulb.

 

[shah4u]

My surgeon told me my valve was tested to last 50 years and it appears he was right.....as the 50th "birthday" will be in Aug., 2017. I spoke with him a few years ago, by phone, and he was surprised I had the SAME valve.......I reminded him that he told me it would last 50 years......and he laughed. You have had the opportunity to research all sides of valve choice and now the decision rests with what YOU think is best for you.

BTW, what is your question?

How about chances of internal bleeding and clot with warfarin and normal injury like cut and scratch ? Also my doc who said to go with mech valve already made a warning regarding in internal bleeding and clot related issues and also the possible consequences in case of clot and further more made a strict NO NO to biking and any sharp stuff ?

 

[Superman]

How about chances of internal bleeding and clot with warfarin and normal injury like cut and scratch ? Also my doc who said to go with mech valve already made a warning regarding in internal bleeding and clot related issues and also the possible consequences in case of clot and further more made a strict NO NO to biking and any sharp stuff ?

Well managed warfarin is not a big issue. The risks generally come into play for those patients who don't manage it well. With home testing done relatively frequently - this is less of a risk than ever. When I first got my valve, I was required to drive to the lab and get blood drawn monthly. Home monitoring wasn't an option. This wasn't always easy to make the time to do, so I would let it go. Embarrassingly long sometimes (six months even). Issues certainly can and did result from poor testing habits.

Now, I poke a finger once a week and call in my result.

I was a fairly active mountain biker (casually) in my 20's (post op). I also played pick-up basketball at a local health club. I've had a broken thumb, elbow, and several cuts of various shapes and sizes. I'm not saying do this stuff on purpose, but I've never lived in a bubble since having surgery.

Should I have my wife cut my food for me? What did he mean, "no sharp stuff"? I work on my own cars (for the simpler stuff), I've built cabinets complete with using a miter saw, jig saw, table saw, drills, and a nail gun.

Over 26 years on warfarin and only 44 years young here.

 

[neil]

difficult choice, the thing is who do you listen to? the people who are the experts and do it all the time? or people on a forum? and that's not being awkward just the way I see it, These guys who you are seeing do this op all the time, they also see the outcomes , on here we all have our own personnel feelings and choice, Thats not to say you cant get good information on forums you can, But at the end of the day you have to make a choice, it can be hard,

 

[ashadds]

How about chances of internal bleeding and clot with warfarin and normal injury like cut and scratch ? Also my doc who said to go with mech valve already made a warning regarding in internal bleeding and clot related issues and also the possible consequences in case of clot and further more made a strict NO NO to biking and any sharp stuff ?

I agree sports , contact sports increase danger of risks ..... What did your surgeon say about moderate activity ? I dont think that is restricted ? if you can manage INR level correctly you should be safe...with ON-X its 1.5-2.5 range I believe.... what does your surgeon say about homograft valve ?

 

[cldlhd]

The problem with just relying on the experts is they don't agree on this issue. A lot of this choice comes down to personal preference. Unless it's a major cut where you need immediate medical attention I doubt it would be an issue. Internal bleeding is a bit trickier because you don't see it. Having said that if you're a 27 year old male then for me personally it's a no brainier. If you're physically active, sounds like it, then a tissue would probably make it until your early 40's if you're lucky. Might seem a long way off but trust me it flies by.

 

[Bodhisattva]

Hi shah4u,

This is such a confusing time, figuring out what to do. Doesn't make it any easier when the surgery date is so close either. Plus it's a shock suddenly finding out the valve needs fixing in the first place, let alone trying to figure out what to do next.

One of my doctor surgeons told me, when pushing for tissue, doctors are mostly worried that the patient won't maintain the warfarin treatment after they get the mechanical valve. Maybe the doctor thinks the patient isn't suited to warfarin treatment, they are the type that will forget to take their daily dose or will blow off the INR testing. Because if you get a mechanical valve, you have to do the warfarin part like a habit. You have to do it regularly without fail.

Now if you get a tissue valve, you will have to have another open heart surgery sooner or later. Since you are young, it will be sooner. Before that, the tissue valve will begin to fail just like your native valve did in the first place. As the tissue valve fails, your heart starts to have to work too hard to push the blood through the failing valve. At that point you'll probably start to feel it. You'll start to see your doctor much more frequently for echo tests which are expensive. Then when you finally get the next open heart surgery, you'll have to pay your share of the cost, take time off from work and deal with recovering from the surgery.

If you get a mechanical valve, the odds are you will never have to go through another open heart surgery. But the tradeoff is a commitment to warfarin.

If you feel at this point you don't want to deal with warfarin, you could just go with a tissue valve this time around. Live your life without anticoagulation for now. Do all the risky things without the warfarin part of the risk puzzle. Then when the time inevitably comes, replace the failing tissue valve with a mechanical valve and take on the warfarin part. Being more experienced at that point, you probably won't choose to replace with another tissue valve since at that point you'll know first hand what will happen to the tissue valve sooner or later.

So maybe your doctors are looking at you and thinking, right now at this stage in his life, this patient is not a good candidate for warfarin therapy. We don't get the feeling he will be able to keep it going. If he is unable to keep up with the warfarin therapy, he will be at high risk for a stroke. We would prefer to give him a tissue valve even if this means he has to have another open heart surgery sooner or later. Because the risk of stroke from not doing the warfarin properly is higher than the risk of dying during the second surgery. Something like that? Maybe ask them?

Remember the risk of dying during the second surgery doesn't include all the other related issues with a second surgery like how the tissue valve gradually fails before the second surgery, how you have to take time off work, deal with recovery and all the other costs. But bottom line, it's your body, your life, your choice. Good luck!

 

[Superman]

Ultimately it's a decision we all have to make for ourselves. We can't "know" the outcome until after the fact.

For the most part - people here seem to be happier after surgery having gotten rid of their problem native valve. After that, there doesn't seem to be a lot of regrets, regardless of choice.

If you do go tissue, the good news is that you will get a second chance. And really, who knows what options will be there in 10 - 20 years time? You will likely have bought yourself 10 - 20 years without dealing with warfarin. If that second chance rolls around - you can switch to mechanical at that time.

In my perfect world, assuming everything went exactly as it did for me, and I could have been guaranteed 20 years on a tissue valve (ha-ha) - I would have gone tissue the first time. Would have carried me through to my aneurysm, then I could have gone mechanical when I was a bit more responsible and sedentary.

Or, if they could have predicted my aneurysm and just wrapped it the first time as a preventative measure, I would have stuck with mechanical.